THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL

1 THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALLWITH SPECIFIC PROVISION FOR CHILDREN 5 17 YEARSAFL RESEARCH BOARDAFL MEDICAL OFFICERS' ASSOCIATIONThis document has been published by the AFL as a position statement on the MANAGEMENT of CONCUSSION in AUSTRALIAN FOOTBALL . It is based on guidelines developed by the AFL Medical Officers' Association which incorporate research that has been funded by the AFL Research Board and which was undertaken by Assoc Prof Gavin Davis, Dr Michael Makdissi and Assoc Prof Paul guidelines should be adhered to at all times. Decisions regarding return to play after concussive injuries should only be made by a medical doctor with experience in concussive injuries. March, 2013 THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALLTHE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 3 Summary Any player who has suffered a CONCUSSION or is suspected of having a CONCUSSION must be medically assessed as soon as possible after the injury and must not be allowed to return to play in the same game or train in the same practice session.

2 There should be a trained first aider at every game and the principles of first aid should be used when dealing with any player who is unconscious or injured. A concussed player must not be allowed to return to school or return to training or playing before having a formal medical clearance. For children (players aged 5-17) The child is not to return to play or sport until they have successfully returned to school/learning, without worsening of symptoms. symptom assessment in the child often requires the addition of parent and/or teacher input. It is reasonable for a child to miss a day or two of school after CONCUSSION , but extended absence is uncommon. THE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALLWITH SPECIFIC PROVISION FOR CHILDREN 5 17 YEARSG avin Davis, Michael Makdissi, Paul McCrory March 2013 For trainers, first-aid providers, coaches, umpires, club officials and parents4 AFL MEDICAL OFFICERS ASSOCIATIONTHE MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 5 BackgroundIntroductionIn considering the best practice MANAGEMENT of CONCUSSION in sport, the critical element remains the welfare of the player, both in the short and long 2001, four international conferences have been held to address key issues in the understanding and MANAGEMENT of CONCUSSION in sport.

3 Following each of these meetings, a summary has been published to improve the safety and health of athletes who suffer concussive injuries during participation in sport . The most recent conference was held in Zurich in November 2012. The summary from the Zurich meeting provides the most up-to-date knowledge on CONCUSSION in sport. It also outlines the current best practice MANAGEMENT guidelines.(1)As part of the 2012 meeting, specific recommendations were made for the MANAGEMENT of children. Children require a different approach from adults because their brains are developing, and they need to continue learning and acquiring knowledge. As such, the priority is not just player welfare and return to play, but a critical element is return to school and is CONCUSSION ? Traumatic brain injury is the broad term used to describe injuries to the brain that are caused by trauma.

4 The more severe injuries typically involve structural damage, such as fractures of the skull and bleeding in the brain. Structural injuries require urgent medical attention. CONCUSSION typically falls into the milder spectrum of traumatic brain injury and reflects a disturbance in brain function. CONCUSSION does not involve structural damage or any permanent injury to the brain is caused by trauma to the brain, which can be either direct or indirect ( whiplash injury). When the forces transmitted to the brain are high enough, they can "stun" the nerves and affect the way in which the brain functions. This results in a range of symptoms and signs depending on the area of the brain that is affected. Common symptoms of CONCUSSION include headache, blurred vision, dizziness, nausea, balance problems, fatigue and feeling not quite right.

5 Other common features of CONCUSSION include confusion, memory loss and reduced ability to think clearly and process information. Loss of consciousness is seen in only 10-20% of cases of CONCUSSION in AUSTRALIAN FOOTBALL . That is, the footballer does not have to lose consciousness to have a AFL MEDICAL OFFICERS ASSOCIATIONB ecause we are dealing with a functional injury rather than structural damage, the changes are temporary and recover spontaneously if managed correctly. The recovery process however, is variable from person to person and injury to injury. Most cases of CONCUSSION in AUSTRALIAN FOOTBALL recover within 10-14 days of injury, however in a small number of cases, recovery is delayed over weeks to common is CONCUSSION in AUSTRALIAN FOOTBALL ? CONCUSSION is a relatively common injury in AUSTRALIAN FOOTBALL .

6 The overall incidence rate is 5-6 concussions per 1000 player hours, which equates to an average of 6-7 injuries per team per season. What are the potential complications following CONCUSSION ?A number of complications can occur following CONCUSSION . These include: Higher risk of injury or repeated CONCUSSION on return to play; Prolonged symptoms (lasting more than 14 days); Symptoms of depression and other psychological problems; Severe brain swelling (particularly in young players); and Long term damage to brain general, complications are not common. The risk of complications is thought to be increased by allowing a player to return to play before they have recovered. This is why it is important to recognise CONCUSSION , make the diagnosis and keep the player out of training and competition until the player has symptoms can cause problems with memory and information processing, which interferes with the player s ability to learn in the classroom.

7 It is for this reason that a child is not to return to school until medically cleared to do MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 7 MANAGEMENT guidelines for Suspected ConcussionPresence of any CONCUSSION symptoms or signs ( stunned, confusion, memory problems, balance problems, headache, dizziness, not feeling right)Presence of any factors for urgent hospital referral ( confusion, vomiting, worsening headache)Do not allow player to return to play. Refer to medical doctor for assessment (at venue, local general practice or hospital emergency department)Call for ambulance and refer to hospitalRemove from the ground Assess using pocket CRT ( CONCUSSION Recognition Tool)Implement first aid MANAGEMENT protocol, including cervical spine immobilisationYESNOF igure 1. Summary of the MANAGEMENT of CONCUSSION in AUSTRALIAN FOOTBALL .

8 *Note: for any player with loss of consciousness, basic first aid principles should be used ( Airways, Breathing, ). Care must also be taken with the player s neck, which may have also been injured in the collision. An ambulance should be called, and these players transported to hospital immediately for further assessment and AFL MEDICAL OFFICERS ASSOCIATIONA. Game-day managementThe most important steps in the initial MANAGEMENT of CONCUSSION include:1. Recognising the injury;2. Removing the player from the game3. Referring the player to a medical doctor for assessment. 1. RECOGNISING THE INJURY Visible clues of suspected concussionAny one or more of the following visual clues can indicate a possible CONCUSSION : Loss of consciousness or responsiveness Lying motionless on ground/Slow to get up Unsteady on feet/Balance problems or falling over/Incoordination Grabbing/Clutching of head Dazed, blank or vacant look Confused/Not aware of plays or events Loss of consciousness, confusion and memory disturbance are classical features of CONCUSSION .

9 The problem with relying on these features is that they are not present in every case. Other symptoms that should raise suspicion of CONCUSSION include: headache, blurred vision, balance problems, dizziness, feeling dinged or dazed , don t feel right , drowsiness, fatigue, difficulty concentrating or difficulty remembering. Tool s such as the pocket C oncus sion Recognition Tool (s ee appendix) c an be used to help recognise CONCUSSION . It is important to note however that brief sideline evaluation tools (such as the pocket CONCUSSION Recognition Tool) are designed to help recognise a CONCUSSION . They are not meant to replace a more comprehensive medical assessment and should never be used as a stand-alone tool for the diagnosis and MANAGEMENT of MANAGEMENT OF CONCUSSION IN AUSTRALIAN FOOTBALL 92.

10 REMOVING THE PLAYER FROM THE GAME Initial MANAGEMENT must adhere to the first aid rules, including airway, breathing, circulation, and spinal immobilisation. Any player with a suspected CONCUSSION must be removed from the game. (See section below for MANAGEMENT of the unconscious player.) Due care of the neck/cervical spine must be given when removing any player after a head knock. Immobilisation of the neck in a cervical collar by a qualified first aid provider is required. A full range of child-sized and adult-sized collars should be available at every game. Removing the player from the game allows the first aid provider time and space to assess the player properly. Any player who has suffered a CONCUSSION must not be allowed to return to play in the same game. Do not be swayed by the opinion of the player, trainers, coaching staff, parents or others suggesting premature return to REFERRING THE PLAYER TO A MEDICAL DOCTOR FOR ASSESSMENT MANAGEMENT of head injury is difficult for non-medical personnel.